桶柄样撕裂半月板缝合的临床及影像效果

[目的]分析半月板桶柄样撕裂行关节镜下半月板缝合患者临床及MRI表现,评估术后效果。[方法]回顾性分析本院2012年8月～2015年8月关节镜下桶柄样撕裂半月板行复位缝合,伴前交叉韧带断裂者同时行前交叉韧带重建手术的25例患者,男21例,女4例,平均年龄(28.07±7.08)岁。采用Lysholm、IKDC评分和MRI检查评价治疗效果。[结果]所有患者均顺利完成手术,镜下证实内侧半月板损伤21例,外侧半月板损伤4例;撕裂部位位于红区17例,位于红白区8例;合并前交叉韧带断裂18例,未合并前交叉韧带断裂7例。所有患者随访13～24个月,平均(17.04±2.23)个月。随访过程中,2例单纯半月板缝合患者术后再次出现症状,再次行关节镜下部分切除未愈合的撕裂部分半月板。其余23例患者Lysholm评分由术前的(21.32±5.09)分提高到末次随访时(91.52±4.05)分(P0.05),IKDC膝关节功能主观评分由术前(25.00±4.59)分提高到末次随访时(91.32±4.26)分。MRI复查见半月板撕裂处T2质子相信号较术前明显降低,半月板形态恢复,未见明显新发撕裂,半月板愈合良好。[结论]半月板桶柄样撕裂经关节镜下缝合修复术临床效果满意,合并前交叉韧带损伤者同时进行前交叉韧带重建的效果优于单纯半月板缝合。     

关节镜术后肺栓塞致截瘫1例

患者,男,54岁,因左膝肿胀、疼痛、活动受限2h入院.患者2h前骑自行车时被汽车撞倒,左膝关节下肢着地,关节疼痛,无法站立,拍片后以左膝关节髁间嵴骨折收住院.入院查体:左膝关节肿胀,浮髌试验阳性,内侧间隙压痛明显,内外翻试验阴性,前抽屉试验阳性,Lachman试验阳性,X线检查示左胫骨髁间嵴撕脱骨折;MRI示左膝关节前交叉韧带胫骨附着处撕脱骨折,内侧半月板桶柄样撕裂(见图1a).实验室检查:凝血酶原时间(pt) 13.7 s,激活部分酶原时间(aptt)29.5 s,凝血酶时间(tt) 18.5 s,抗凝血酶三67.5％.诊断:左膝关节前交叉韧带胫骨附着处撕脱骨折,内侧半月板桶柄样撕裂.     

MRI多征象分析诊断半月板桶柄状撕裂

目的探讨MRI多征象分析诊断半月板桶柄状撕裂（BHT）的价值。方法回顾性分析84个经关节镜证实为半月板损伤的膝关节的MR图像,其中42个膝关节为半月板BHT,另42个膝关节为非BHT。观察以下8种征象：双后交叉韧带（PCL）征、半月板翻转征、空领结征、领结残破征、后角残破征、厚饼征、碎块内移征及外周残半月板征,分别计算每种征象诊断半月板BHT的敏感度、特异度、阳性预测值、阴性预测值和准确率。结果双PCL征、半月板翻转征、厚饼征、碎块内移征及外周残半月板征具有相对高的特异度,但除碎块内移征及外周残半月板征的敏感度相对高外,其余6种MRI征象的敏感度均较小。结论半月板BHT可有多种MRI表现,碎块内移征与外周残半月板征最具诊断价值,而双PCL征、半月板翻转征及厚饼征特异度较高,这些征象的出现强烈提示半月板BHT。     

膝关节内外侧半月板后根部撕裂的MRI诊断价值

目的:探讨MRI对膝关节内外侧半月板后根部撕裂的诊断价值。方法:回顾性分析2012年1月至2016年1月,关节镜下证实为半月板后根部撕裂的患者43例。其中男25例,女18例;年龄27~69(42.5±8.3)岁;右侧27例,左侧16例。由2名医师采用双盲法独立回顾性分析经关节镜证实的43例半月板后根部撕裂患者的MRI表现,计算MRI对半月板后根部撕裂的诊断敏感性、特异性和准确性,并计算膝关节韧带损伤及半月板脱位等伴随情况。结果:143例中,关节镜手术证实43例半月板后根部撕裂,包括内侧撕裂24例,外侧撕裂19例。医师A诊断内侧半月板后根部撕裂的敏感性、特异性、准确性分别为91.67%、86.6%、83.9%,伴内侧半月板突出19例,伴前交叉韧带撕裂2例;外侧半月板后跟部撕裂的敏感性、特异性、准确性分别为73.7%、79.9%、79%,伴外侧半月板突出4例,伴前交叉韧带撕裂16例。医师B诊断内侧半月板后根部撕裂的敏感性、特异性、准确性分别为87.5%、87.4%、87.4%,伴内侧半月板突出19例,伴前交叉韧带撕裂2例;外侧半月板后跟部撕裂的敏感性、特异性、准确性分别为78.9%、82.3%、82.5%,伴外侧半月板突出4例,伴前交叉韧带撕裂16例。2名医师采用MRI诊断内、外侧半月板后根部撕裂的一致性均好,Kappa值分别为0.81和0.67。结论 :膝关节MRI诊断内外侧半月板后跟部撕裂及其伴随征象具有较大价值,为临床医生术前诊断提供依据,值得临床推广应用。     

膝关节MR检查对100例交叉韧带损伤患者的诊断作用研究分析

目的研究分析核磁共振对膝关节交叉韧带损伤患者的临床诊断价值及特点。方法选取2016年1月至2017年7月本院收治的怀疑为膝关节前交叉韧带损伤患者100例,所有患者均行CT、MRI检查,检查后2~4天以内行关节镜检查,最终CT、MRI诊断结果以关节镜检查结果作为判断准确度的金标准。观察并比较CT、MRI检查前交叉韧带损伤诊断结果及前交叉韧带的损伤在CT及MRI影像学检查的表现。结果本研究100例患者,经关节镜检查结果显示,22例无韧带损伤(22.0%),34例为部分韧带撕裂(34.0%),剩余44例为完全韧带撕裂(44.0%)。CT检查前交叉韧带的诊断为80.0%(80/100),MRI检查前交叉韧带的诊断率为97.0%(97/100),差异具有统计学意义(χ~2=5.0493,P0.05);MRI检查结果显示,完全韧带撕裂的后交叉韧带角度、后交叉韧带弯曲度指数、前交叉韧带与胫骨内侧平舌矢状面夹角均明显小于无韧带损伤及部分韧带撕裂,比较差异具有统计学意义P0.05。结论 MRI在诊断前交叉韧带损伤方面具有明显优势,其对软组织的分辨率及对比度均较高,可以清晰显示关节整体结构及韧带、半月板损伤情况等,可作为交叉韧带损伤诊断的重要检查方法。     

前交叉韧带合并内侧半月板桶柄样撕裂同期修复12例分析

目的探讨前交叉韧带(Anterior cruciate ligament,ACL)合并内侧半月板桶柄样撕裂同期修复的临床疗效。方法对2013年10月至2015年12月,本院经治的ACL合并内侧半月板桶柄样撕裂患者12例,进行随访。男7例,女5例;年龄19~55岁,平均29.2岁。左膝5例,右膝7例,病程2天~1.6年。临床主要表现为膝关节不稳,疼痛,弹响,绞锁。本组均采用同期ACL重建联合内侧半月板缝合术,术前、术后采用Lysholm评分及IKDC评分评价膝关节功能,根据Barrett标准评判半月板愈合情况。结果本组12例,12例均获随访6个月~1年,平均7.8个月,术后3个月和6个月随访Lysholm评分为:(76.5±2.2),(94.8±1.4),较术前(36.6±4.3)明显提高,术后3个月和6个月随访IKDC评分依次为:(79.5±0.8),(94.4±0.9),较术前(39.8±3.3)明显改善。MRI示半月板愈合9例,1例因再次撕裂行手术治疗,愈合率75.0%。结论 ACL合并内侧半月板桶柄样撕裂应早期、同期修复,愈合率高,临床效果满意。     

前交叉韧带合并不同类型半月板损伤的治疗策略

背景:前交叉韧带合并半月板损伤临床常见,针对不同的损伤类型,采取不同的治疗策略,对术后膝关节功能恢复至关重要。目的目的:研究前交叉韧带合并半月板不同损伤类型的特点,探讨相应的治疗策略。方法方法:选取2005年10月至2013年12月期间收治的前交叉韧带合并半月板损伤患者139例,男98例,女41例;年龄13~71岁,平均31.2岁;左膝62例,右膝77例,病程5 d至1.6年,陈旧性损伤(病程>3周)32例,新鲜性损伤(病程≤3周)107例。患者均有外伤史。临床主要表现为膝关节不稳、疼痛、弹响、绞锁。将术中镜下影像资料进行分析,统计前交叉韧带合并半月板损伤的类型特征及手术方式。结果结果:所有病例均采用关节镜微创手术治疗,前交叉韧带完全断裂113例,部分断裂26例。外侧半月板损伤46例(盘状半月板损伤8例,胫骨髁间棘撕脱2例)占33.1%,内侧半月板损伤65例(46.7%),内外侧半月板同期损伤28例(20.2%)。半月板纵行撕裂42例(桶柄状撕裂24例),水平状撕裂8例,斜行撕裂36例,瓣状撕裂13例,横断性撕裂12例,复合性撕裂28例。前交叉韧带重建139例,半月板部分切除36例,半月板缝合103例。结论结论:陈旧性前交叉韧带合并半月板损伤以外侧半月板多见,急性损伤以内侧半月板损伤为主。内外侧半月板同期损伤多见于陈旧性损伤。陈旧性损伤多数需要半月板部分切除,急性损伤多数可以缝合。前交叉韧带合并半月板损伤应早期手术。     

膝关节半月板撕裂的磁共振表现

目的进一步认识膝关节半月板撕裂的磁共振成像(MRI)表现。方法回顾分析50例膝关节半月板撕裂的MRI资料,所有病例均经关节镜手术证实。采用永磁型MRI机,场强0.2T。结果50例半月板撕裂中,按照部位分类,半月板撕裂位于内侧半月板前角2例,内侧后角37例,外侧半月板前角5例,外侧后角3例,同时累及半月板前角、体部和后角者内侧2例,外侧1例。按照半月板撕裂的形式分为:水平撕裂8例;垂直撕裂4例;斜形撕裂26例;纵形撕裂3例;放射状撕裂4例;桶柄状撕裂2例;复杂撕裂3例。结论MRI能够清楚显示膝关节半月板撕裂的部位和形式,为临床治疗提供可靠的依据,是目前诊断半月板撕裂的最好的影像学检查方法。     

下肢

PF膨胀式髓内钉治疗股骨转子间骨折；股骨干骨折合并同侧股骨颈骨折的诊断与治疗；外固定支架在治疗儿童股骨干骨折中的应用;自体髌腱与自体四股凰绳肌腱重建前交叉韧带对髌股关节软骨影响的关节镜对比观察研究;MRI检查对半月板桶柄状撕裂的诊断价值研究;膝关节镜下同种异体半月板移植术（附2例初步报告）;[编者按]     

膝关节半月板和韧带损伤磁共振成像诊断

目的探讨磁共振成像(MRI)对膝关节损伤诊断价值和意义。方法行MRI检查并经手术或关节镜证实的病例27例,采用西门子公司1.5T超导型磁共振成像系统。均做矢状及冠状面扫描,层厚4mm。对8例有前交叉韧带(ACL)损伤和22个没有ACL损伤的膝关节,分别测量后交叉韧带(PCL)角和弯曲度指数,并进行统计学分析。结果23例31个半月板损伤,术前MRI确诊18例,24个半月板,确诊率分别为62.07%和77.42%。半月板损伤的MRI表现:①半月板内可见线条样异常信号影,延伸到关节表面(Ⅲ度);②半月板变小,内侧缘变纯;③半月板失去正常三角形结构;④半月板边缘凹凸不平,呈波浪状改变;⑤半月板外缘与关节囊之间距离增宽。在9例有ACL损伤的病例中,仅有5例术前得到明确诊断,确诊率为55.56%。PCL角和弯曲度指数测量结果在ACL损伤组和非损伤组间具有显著性差异(P<0.01)。结论MRI对半月板和韧带损伤绝大多数能显示损伤的部位和程度,但诊断半月板损伤时,应注意辨别易混淆的正常结构和有些容易漏诊的MRI表现;对可疑ACL损伤者,在观察直接征象同时,应注意分析间接征像。     

The triple PCL sign: bucket handle tears of both medial and lateral menisci in a chronically ACL-deficient knee

Bucket handle tears of both menisci in the setting of acute or chronic anterior cruciate ligament (ACL) tears of the same knee have rarely been reported in the literature. This article presents a case of a bucket handle tear affecting both the medial and lateral menisci in a patient with chronic ACL rupture. Both bucket handle tears were displaced and locked in the intercondylar notch. A new magnetic resonance image (MRI) sign suggested on sagittal view is called the triple PCL sign, comprising the intact posterior cruciate ligament (PCL) and the 2 displaced fragments in the intercondylar notch from the two bucket handle tears. The precise diagnosis of this condition is of obvious importance for optimal operative planning. While finding the displaced fragment from the medial meniscus is expected to cause the double PCL sign, the torn ACL may have made it easier to visualize the bucket handle tear of the lateral meniscus in the same sagittal plane as the PCL. Only 5 other reports mention bimeniscal bucket handle tears of both the medial and lateral menisci in association with an ACL tear. None have shown the suggested triple PCL sign because of lack of overlap between the 2 bucket handle tears in the coronal plane while lying in the intercondylar notch causing them not to fall in the same sagittal plane. Our patient showed some overlap between the 2 meniscal fragments while lying in the notch to create the triple PCL sign on sagittal MRI.     

Microvasculature of the human medial meniscus: operative findings.

The purpose of our study was to weigh the probability of a successful meniscus repair on the basis of the microvasculature of the human medial meniscus. In a series of 105 patients who underwent an anterior cruciate ligament reconstruction between January 1985 and December 1986, we chose the 40 patients who had a subtotal medial meniscectomy (38%) to study the microvasculature of the human medial meniscus adequately; the other patients had either an intact meniscus (23%), a meniscus repair (29%), or an already removed meniscus (10%). Forty medial menisci, from 40 male patients with an average age of 27 years, having an anterolateral and/or anteromedial chronic knee laxity and an associated meniscal pathology, were subdivided into two groups: (a) 20 tears restricted to the posterior horn, and (b) 20 bucket-handle tears observed under light microscopy. Meaningful capillary plexuses penetrating into the meniscal stroma were found in 18 of 40 menisci (45%). They were easier to identify in posterior horn tears (55%) than in bucket-handle tears (35%), and were found especially in younger patients (22 years on the average). Therefore, we encourage meniscus repairs even in chronic tears, particularly in younger patients and in posterior-horn tears.     

Kombinierte Verletzung des Innen- und Außenmeniskus und des vorderen Kreuzbandes

THE PROBLEM: Combined injury of the medial and lateral meniscus and the anterior cruciate ligament. THE SOLUTION: One-stage arthroscopic treatment of all injuries. Repair of the bucket-handle tears with sutures and arrow-shaped implants. SURGICAL TECHNIQUE: Arthroscopy of the knee joint, repositioning of the buckethandle tears of the medial and lateral menisci. Evaluation of the stability of the menisci without sutures, insertion of horizontal and vertical sutures through the menisci in inside-out technique, refixation of the posterior horns with arrow-shaped meniscus implants. Reconstruction of the anterior cruciate ligament with a patellar tendon transplant. Knotting of the suture loops through the menisci directly onto the capsule. RESULT: Stable knee joint capable of load bearing and without signs of irritation after 12 weeks with a range of motion of 0/0/130 degrees. Slight muscle deficit in the right thigh.     

The relationship between intra-articular meniscal,chondral, and ACL lesions: finding from 1,774 knee arthroscopy patients and evaluation by gender

Knowing the relationship between diagnoses is important in knee arthroscopy in terms of defining possible treatment modalities preoperatively. The purpose of our study was to define the diagnoses made intraoperatively through knee arthroscopy and the relationships between them. We evaluated the results of knee arthroscopies performed over a 10-year period. The sites and sizes of chondral lesions, the existence of anterior cruciate ligament (ACL) injury, and the sites of meniscal lesions were noted for a total of 1,774 patients. The relationships between these lesions were evaluated statistically. Chondral lesions and posterior medial meniscal tears were predominant in females, whereas complete ACL tears were predominant in males. ACL tears were commonly accompanied by medial and lateral meniscal bucket-handle tears. In cases with advanced chondral lesions, medial and lateral posterior meniscal and lateral anterior meniscal tears were more common. According to our results, posterior tears of the medial menisci, medial and lateral femoral condyles, lateral tibial plateau type 3 or 4 cartilage lesions, and the rate of diagnostic arthroscopy were higher in females, while middle substance and bucket-handle tears of medial menisci and total rupture of the ACL were more common in males. ACL injuries were seen to coexist with medial or lateral menisci bucket-handle tears, with no relationship between the site or size of the chondral lesions. A relationship between medial and lateral meniscal tears and the site of femoral and tibial chondral surface lesions was detected.     

异常加深的股骨外侧髁压迹是前交叉韧带撕裂的间接证据

目的:探讨股骨外侧髁压迹异常程度与前交叉韧带损伤之间的关系.方法:回顾研究2013年1月至2013年11月治疗的前交叉韧带损伤16例患者的X线片和MRI影像学资料,其中男14例,女2例;左膝关节5例,右膝关节11例;年龄19～52岁,平均28.3岁.膝关节侧位X线或MRI矢状位提示股骨外侧髁压迹有异常,使用影像PACS系统中测量工具测量压迹的深度,并分析患者病历资料、体格检查及关节镜术中影像学资料.结果:4例侧位X线片和MRI矢状位可见股骨外侧髁压迹异常并深度2.0 mm,MRI示前交叉韧带撕裂,前抽屉试验和拉姆征均阳性,关节镜探查手术证实前交叉韧带完全撕裂;2例侧位X线片股骨外侧髁压迹未见异常,但MRI矢状位示股骨外侧髁压迹异常并深度1.0 mm,MRI示前交叉韧带撕裂,前抽屉试验和拉姆征均阳性,MRI示前交叉韧带撕裂,其中1例关节镜探查手术证实前交叉韧带完全撕裂,另1例因未行手术探查而无法证实是否完全断裂.结论:膝关节侧位X线片上股骨外侧髁压迹异常加深与前交叉韧带撕裂有密切相关,异常加深的股骨外侧髁压迹是前交叉韧带撕裂的间接证据.     

Both medial and lateral bucket-handle meniscus tears associated with chronic ACL injury: A rare presentation of triple-PCL sign

BackgroundSeveral types of meniscal tear could be presented in both acute and chronic anterior cruciate ligament injury. The incidence of bucket-handle meniscus tears can be up to 30% of the overall meniscus tears cases. The case of both compartment (medial and lateral) bucket-handle meniscus is rarely occurred.CaseA case of both medial and lateral bucket-handle meniscus tears was reported in a male of 21 years old. The patient also had a chronic anterior cruciate ligament injury. The magnetic resonance imaging also showed a rare presentation of the triple-PCL sign with the sagittal view. Arthroscopic surgery with a meniscus repair and anterior cruciate ligament reconstruction was performed on the patient.ConclusionsSeveral specific imaging signs including triple-PCL sign could be presented in a rare case of both medial and lateral bucket-handle meniscus tears. Recognition of this sign is important to have accurate preoperative diagnosis and proper treatment plan.     

Anterior cruciate ligament and intercondylar notch in the coronal oblique plane: anatomy complemented by magnetic resonance imaging in cruciate ligament-intact knees.

We assessed the anatomy of the anterior cruciate ligament (ACL) and femoral intercondylar notch on cryosections from one cadaveric knee specimen in the coronal oblique plane oriented parallel to the intercondylar roof. We determined the course of the ACL, the widths of the cruciate ligaments at intersection, and the intercondylar notch configuration on coronal oblique plane magnetic resonance images in 51 adult cruciate ligament-intact knees (25 women, 26 men; age range, 16 to 47 years). The intercondylar notch widths were measured at the notch entrance, at the intersection of the ACL and posterior cruciate ligament (PCL), and at the notch outlet. In the coronal oblique plane, the ACL exhibited a diagonal course from the central and medial part of the anterior intercondylar area of the tibia distally, across the lateral third of the intercondylar notch, to the intercondylar surface of the lateral femoral condyle proximally. At the cruciate ligament intersection, the absolute widths of the ACLs measured on average 6.1+/-1.1 mm in men and 5.2+/-1.0 mm in women representing 31.9% and 31.1% of the ACL/central intercondylar notch width ratios. The absolute widths of the PCLs measured on average 9.6+/-1.3 mm in men and 8.5+/-1.3 mm in women representing 50.4% and 51.4% of PCL/central intercondylar notch width ratios. On average for both groups, men and women, the absolute widths of the PCLs were significantly larger than the absolute widths of the ACLs. However, the relative widths of the cruciate ligaments with respect to corresponding intercondylar notch widths were not significantly different. In the coronal oblique plane, the intercondylar notch widths showed on average a significant decrease from posterior to intersection and from intersection to anterior. At notch outlet, the mean notch width measured 21.4 mm in men and 18.5 mm in women. At intersection, the mean notch width measured 19.1 mm in men and 16.6 mm in women. At notch entrance, the notch width measured 14.6+/-1.8 mm in men and 12.7+/-2.1 mm in women. We recommend magnetic resonance tomography of the knee in the coronal oblique plane oriented parallel to the intercondylar roof as the imaging modality of choice to visualize accurately the anatomic diagonal course of the ACL and its relation to the intercondylar notch and posterior cruciate ligament complex.     

Evaluation of anatomic risk factors using magnetic resonance imaging in non-contact anterior cruciate ligament injury

BackgroundThe purpose of our study was to compare the significance of the tibio-femoral morphological variables (notch width index, notch shape index, intercondylar notch angle, medial and lateral tibial slopes) in predicting non-contact ACL (anterior cruciate ligament) injuries and to compare these factors between genders in South Asian population. The author hopes to provide a comprehensive analysis on the risk factors which would help in betterment of the patients at danger for anterior cruciate ligament injury.Materials and methodsA total of 110 MRI knees of patients with 55 subjects of noncontact ACL injury and 55 age and sex matched controls were included in a retrospective study. Notch width index, notch shape index, intercondylar notch angle were assessed in axial and coronal MR imaging along with medial and lateral posterior tibial slopes. Morphology of the notch was also assessed.ResultsACL injured group were found to have a statistically significant narrow notch width index and decreased intercondylar notch angle with increased lateral posterior tibial slope. Type-A notches were found to have increased risk of having ACL injuries. Gender comparative results showed no statistically significant differences.ConclusionACL tears are associated with decreased notch width index, intercondylar notch angle and increased lateral posterior tibial slope. Type-A notches are seen to have increased risk for ACL injuries.